| NPI | 1750278875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 135505) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 135505-121) |
| Enumeration Date | 2025-06-20 |
| Last Update Date | 2025-06-27 |